早产儿围产期高氨血症临床危险因素分析
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摘要
目的研究早产儿围产期高氨血症的临床危险因素。方法选择2016年5月至2017年5月湖南省妇幼保健院收治的71例高氨血症早产儿纳入观察组,同时选择75例血氨正常的早产儿作为对照组。比较2组早产儿基本临床资料,包括性别、胎龄、体质量、血常规、凝血功能、头颅超声检查结果等。观察2组早产儿的不良症状,包括喂养困难、呕吐、意识障碍、四肢肌张力减低、呼吸急促等。比较观察组不同预后早产儿血氨水平。采用多因素Logistic回归分析早产儿发生高氨血症的危险因素。结果 2组早产儿性别、胎龄、体质量比较,差异均无统计学意义(均P> 0. 05);观察组代谢性酸中毒、电解质紊乱、凝血功能障碍和头颅超声异常比例均明显高于对照组[40. 8%(29/71)比21. 3%(16/75)、45. 1%(32/71)比17. 3%(13/75)、32. 4%(23/71)比17. 3%(13/75)、43. 7%(31/71)比14. 7%(11/75)],差异均有统计学意义(均P <0. 05)。2组喂养困难、呕吐比例比较差异均无统计学意义(均P> 0. 05);观察组意识障碍、四肢肌张力减低、呼吸急促比例均明显高于对照组,差异均有统计学意义(均P <0. 05)。观察组早产儿有52例预后良好,19例预后不良。预后良好和预后不良早产儿出生后24 h血氨水平比较差异无统计学意义(P>0. 05);预后不良早产儿出生后48、72、96 h血氨水平均明显高于预后良好早产儿,差异均有统计学意义(均P <0. 05)。多因素Logistic回归分析结果显示,胎膜早破、出生后体内感染和剖宫产是早产儿发生高氨血症的独立危险因素(比值比=0. 612、1. 486、1. 324,95%置信区间:0. 278～0. 831、1. 143～1. 867、1. 127～1. 684,均P <0. 05)。结论胎膜早破、出生后体内感染和剖宫产是早产儿发生高血氨症的危险因素,需要有效监测血氨水平,血氨水平与早产儿预后相关,需采取有效措施减轻高氨血症对早产儿的危害。
Objective To analyze the risk factors of hyperammonemia in preterm infants. Methods From May 2016 to May 2017,71 premature infants with hyperammonemia and 75 premature infants with normal blood ammonia were enrolled in Hunan Provincial Maternal and Child Health Care Hospital. Basic clinical data including gender,gestational age,weight,blood routine,coagulation function and cranial ultrasonographic findings were recorded. Clinical symptoms including feeding intolerance,vomiting,conscious disturbance,limb dystonia and shortness of breath were observed. Level of blood ammonia was analyzed among infants with different prognosis in observation group. Risk factors of hyperammonemia were analyzed by multivariate logistic regression. Results There was no significant difference of gender,gestational age and body mass between groups( all P > 0. 05). Rates of metabolic acidosis,electrolyte disturbance,coagulation dysfunction and abnormality of cranial ultrasound in observation group were significantly higher than those in control group[40. 8%( 29/71) vs 21. 3%( 16/75),45. 1%( 32/71) vs 17. 3%( 13/75),32. 4%( 23/71) vs 17. 3%( 13/75),43. 7%( 31/71) vs 14. 7%( 11/75) ]( all P < 0. 05). There was no significant difference of feeding intolerance and vomiting between groups( both P > 0. 05). Rates of consciousness disorder,limb dystonia and shortness of breath in observation group were significantly higher than those in control group( all P < 0. 05). In observation group,52 cases had good prognosis and 19 cases had poor prognosis; there was no significant difference of blood ammonia level at 24 h after birth between them( P > 0. 05); blood ammonia levels at 48,72 and 96 h after birth in infants with poor prognosis were significantly higher than those in infants with good prognosis( P < 0. 05). Multivariate logistic regression showed that premature rupture of membranes,postnatal infection and cesarean section were independent risk factors of hyperammonemia( odds ratio = 0. 612,1. 486,1. 324; 95% confidence interval: 0. 278-0. 831,1. 143-1. 867,1. 127-1. 684,all P < 0. 05). Conclusion Blood ammonia level is associated with the prognosis of preterm infants,especially in the cases with premature rupture of membranes,postnatal infection and cesarean section.
Objective To analyze the risk factors of hyperammonemia in preterm infants. Methods From May 2016 to May 2017,71 premature infants with hyperammonemia and 75 premature infants with normal blood ammonia were enrolled in Hunan Provincial Maternal and Child Health Care Hospital. Basic clinical data including gender,gestational age,weight,blood routine,coagulation function and cranial ultrasonographic findings were recorded. Clinical symptoms including feeding intolerance,vomiting,conscious disturbance,limb dystonia and shortness of breath were observed. Level of blood ammonia was analyzed among infants with different prognosis in observation group. Risk factors of hyperammonemia were analyzed by multivariate logistic regression. Results There was no significant difference of gender,gestational age and body mass between groups( all P > 0. 05). Rates of metabolic acidosis,electrolyte disturbance,coagulation dysfunction and abnormality of cranial ultrasound in observation group were significantly higher than those in control group[40. 8%( 29/71) vs 21. 3%( 16/75),45. 1%( 32/71) vs 17. 3%( 13/75),32. 4%( 23/71) vs 17. 3%( 13/75),43. 7%( 31/71) vs 14. 7%( 11/75) ]( all P < 0. 05). There was no significant difference of feeding intolerance and vomiting between groups( both P > 0. 05). Rates of consciousness disorder,limb dystonia and shortness of breath in observation group were significantly higher than those in control group( all P < 0. 05). In observation group,52 cases had good prognosis and 19 cases had poor prognosis; there was no significant difference of blood ammonia level at 24 h after birth between them( P > 0. 05); blood ammonia levels at 48,72 and 96 h after birth in infants with poor prognosis were significantly higher than those in infants with good prognosis( P < 0. 05). Multivariate logistic regression showed that premature rupture of membranes,postnatal infection and cesarean section were independent risk factors of hyperammonemia( odds ratio = 0. 612,1. 486,1. 324; 95% confidence interval: 0. 278-0. 831,1. 143-1. 867,1. 127-1. 684,all P < 0. 05). Conclusion Blood ammonia level is associated with the prognosis of preterm infants,especially in the cases with premature rupture of membranes,postnatal infection and cesarean section.
引文
[1]曾云清,曹蓓,彭湘莲. 73例早产儿高氨血症临床资料分析[J].中国妇幼卫生杂志,2016,7(4):69-71. DOI:10. 19757/j. cnki.issn1674-7763. 2016. 04. 019.Zeng YQ,Cao B,Peng XL. Analysis of clinical data of 73 cases of premature infants with hyperammonemia[J]. Chinese Journal of Women and Children Health,2016,7(4):69-71. DOI:10. 19757/j. cnki. issn1674-7763. 2016. 04. 019.
[2]陈亚南,张媞,徐善森,等.丙戊酸钠联用新型抗癫痫药对癫痫患儿血氨的影响[J].中国临床药理学杂志,2016,32(15):1378-1380. DOI:10. 13699/j. cnki. 1001-6821. 2016. 15. 010.Chen YN,Zhang T,Xu SS,et al. Effect of valproic acid coadministred with new antiepileptic drugs on epileptic children's ammonia[J].Chinese Journal of Clinical Pharmacology,2016,32(15):1378-1380. DOI:10. 13699/j. cnki. 1001-6821. 2016. 15. 010.
[3]诸葛小寅,徐潇,金标.新生儿缺氧缺血性脑病的相关影响因素分析[J].中国妇幼保健,2017,32(23):5927-5929. DOI:10.7620/zgfybj. j. issn. 1001-4411. 2017. 23. 44.Zhuge XY,Xu X,Jin B. Analysis of related factors in neonates with hypoxic ischemic encephalopathy[J]. Maternal&Child Health Care of China,2017,32(23):5927-5929. DOI:10. 7620/zgfybj. j. issn. 1001-4411. 2017. 23. 44.
[4]孟春阳.微生态制剂对肝性脑病患者肝功能血氨水平及神经症状的影响[J].中国实用神经疾病杂志,2016,19(10):104-105.DOI:10. 3969/j. issn. 1673-5110. 2016. 10. 067.Meng CY. Effect of microecological preparation on hepatic function blood ammonia level and neurological symptoms in patients with hepatic encephalopathy[J]. Chinese Journal of Practical Nervous Diseases,2016,19(10):104-105. DOI:10. 3969/j. issn. 1673-5110. 2016. 10. 067.
[5]王恋,李娟,毛健,等.极低及超低出生体重儿的预后因素分析[J].中国当代儿科杂志,2014,16(6):601-605.Wang L,Li J,Mao J,et al. Prognostic factors in very low birth weight infants and extremely low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics,2014,16(6):601-605.
[6]李爱丽.早产儿脑损伤的危险因素及预后[J].中国实用神经疾病杂志,2017,20(11):103-105. DOI:10. 3969/j. issn. 1673-5110. 2017. 11. 041.Li AL. Risk factors and prognosis of brain injury in premature infants[J]. Chinese Journal of Practical Nervous Diseases,2017,20(11):103-105. DOI:10. 3969/j. issn. 1673-5110. 2017.11. 041.
[7]李杰,王译,李晓华,等.未足月胎膜早破后极低出生体重儿脑损伤的危险因素分析[J].西南医科大学学报,2017,40(5):475-479. DOI:10. 3969/j. issn. 2096-3351. 2017. 05. 014.Li J,Wang Y,Li XH,et al. Risk factors for brain injury in very-low-birth-weight infants after preterm premature rupture of the membranes[J]. Journal of Luzhou Medical College,2017,40(5):475-479. DOI:10. 3969/j. issn. 2096-3351. 2017. 05. 014.
[8]牟静,华子瑜.新生儿脑病相关危险因素研究进展[J].儿科药学杂志,2018,24(1):57-60. DOI:10. 13407/j. cnki. jpp. 1672-108X. 2018. 01. 020.Mou J, Hua ZY. Research progress on risk factors related to neonatal encephalopathy[J]. Journal of Pediatric Pharmacy,2018,24(1):57-60. DOI:10. 13407/j. cnki. jpp. 1672-108X.2018. 01. 020.
[9]曹蓓,彭湘莲,曾云清.新生儿高氨血症相关影响因素分析[J].现代诊断与治疗,2013,24(3):668-669. DOI:10. 3969/j. issn.1001-8174. 2013. 03. 144.Cao B,Peng XL,Zeng YQ,et al. Analysis of related factors of neonatal hyperammonemia[J]. Modern Diagnosis&Treatment,2013,24(3):668-669. DOI:10. 3969/j. issn. 1001-8174. 2013.03. 144.
[10]李智英,司徒妙琼,吕林华.低出生体质量儿PICC置管后导管相关并发症的相关因素分析[J].重庆医学,2017,46(34):4886-4888. DOI:10. 3969/j. issn. 1671-8348. 2017. 34. 048.Li ZY, Situ MQ, Lyu LH. Related factors of catheter-related complications in low birth weight infants after PICC catheterization[J].Chongqing Medicine,2017,46(34):4886-4888. DOI:10. 3969/j. issn. 1671-8348. 2017. 34. 048.
[11]袁继红.早产儿脑室内出血高危因素分析与护理对策[J].公共卫生与预防医学,2016,27(6):116-117.Yuan JH. Analysis of high risk factors of intraventricular hemorrhage in premature infants and nursing countermeasures[J]. Journal of Public Health and Preventive Medicine,2016,27(6):116-117.
[12]谭竹,王莉.围产期早产儿脑病危险因素研究进展[J].中华临床医师杂志(电子版),2016,10(2):252-255. DOI:10. 3877/cma. j. issn. 1674-0785. 2016. 02. 022.Tan Z,Wang L. Research progress of perinatal risk factors of premature encephalopathy[J]. Chinese Journal of Clinicians(Electronic Edition),2016,10(2):252-255. DOI:10. 3877/cma. j. issn. 1674-0785. 2016. 02. 022.
[13]周光鹏,朱志军,孙丽莹,等.活体肝移植治疗鸟氨酸氨甲酰基转移酶缺乏症3例报告及文献复习[J].首都医科大学学报,2017,38(6):824-826. DOI:10. 3969/j. issn. 1006-7795. 2017.06. 009.Zhou GP,Zhu ZJ,Sun LY,et al. Living donor liver transplantation for ornithine carbamyltransferase deficiency:3 cases report and literature review[J]. Journal of Capital Medical University,2017,38(6):824-826. DOI:10. 3969/j. issn. 1006-7795. 2017. 06. 009.
[14]张喆,贺娟,陈晓文,等.新生儿高氨血症30例[J].实用儿科临床杂志,2011,26(12):949-951. DOI:10. 3969/j. issn. 1003-515X. 2011. 12. 020.Zhang Z,He J,Chen XW,et al. Clinical analysis of hyperammonemia in 30 neonates[J]. Journal of Applied Clinical Pediatrics,2011,26(12):949-951. DOI:10. 3969/j. issn. 1003-515X. 2011.12. 020.
[15]冯向春,王娜,徐元芹.青岛地区90例高危新生儿遗传代谢病的研究[J].中国优生与遗传杂志,2013,21(8):93-94. DOI:10. 13404/j. cnki. cjbhh. 2013. 08. 075.Feng XC,Wang N,Xu YQ. Study of inherited metabolism diseases in 90 newborn infants with high risk[J]. Chinese Journal of Birth Health&Heredity,2013,21(8):93-94. DOI:10. 13404/j. cnki.cjbhh. 2013. 08. 075.
[16]岳晓红.浅析干化学法测定患儿血氨的影响因素及质量控制[J].中国卫生检验杂志,2015,25(24):4362,4365.Yue XH. Influencing factors and quality control of dry chemical method for determination of blood ammonia in children[J].Chinese Journal of Health Laboratory Technology,2015,25(24):4362,4365.
[17]张媞,徐善森,杨帆,等.丙戊酸治疗癫痫患儿诱发高氨血症的危险因素分析[J].中国临床药理学杂志,2016,32(4):363-365. DOI:10. 13699/j. cnki. 1001-6821. 2016. 04. 026.Zhang T,Xu SS,Yang F,et al. Risk factors for hyperammonemia associated with valproic acid therapy in epileptic children[J]. The Chinese Journal of Clinical Pharmacology,2016,32(4):363-365.DOI:10. 13699/j. cnki. 1001-6821. 2016. 04. 026.
[2]陈亚南,张媞,徐善森,等.丙戊酸钠联用新型抗癫痫药对癫痫患儿血氨的影响[J].中国临床药理学杂志,2016,32(15):1378-1380. DOI:10. 13699/j. cnki. 1001-6821. 2016. 15. 010.Chen YN,Zhang T,Xu SS,et al. Effect of valproic acid coadministred with new antiepileptic drugs on epileptic children's ammonia[J].Chinese Journal of Clinical Pharmacology,2016,32(15):1378-1380. DOI:10. 13699/j. cnki. 1001-6821. 2016. 15. 010.
[3]诸葛小寅,徐潇,金标.新生儿缺氧缺血性脑病的相关影响因素分析[J].中国妇幼保健,2017,32(23):5927-5929. DOI:10.7620/zgfybj. j. issn. 1001-4411. 2017. 23. 44.Zhuge XY,Xu X,Jin B. Analysis of related factors in neonates with hypoxic ischemic encephalopathy[J]. Maternal&Child Health Care of China,2017,32(23):5927-5929. DOI:10. 7620/zgfybj. j. issn. 1001-4411. 2017. 23. 44.
[4]孟春阳.微生态制剂对肝性脑病患者肝功能血氨水平及神经症状的影响[J].中国实用神经疾病杂志,2016,19(10):104-105.DOI:10. 3969/j. issn. 1673-5110. 2016. 10. 067.Meng CY. Effect of microecological preparation on hepatic function blood ammonia level and neurological symptoms in patients with hepatic encephalopathy[J]. Chinese Journal of Practical Nervous Diseases,2016,19(10):104-105. DOI:10. 3969/j. issn. 1673-5110. 2016. 10. 067.
[5]王恋,李娟,毛健,等.极低及超低出生体重儿的预后因素分析[J].中国当代儿科杂志,2014,16(6):601-605.Wang L,Li J,Mao J,et al. Prognostic factors in very low birth weight infants and extremely low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics,2014,16(6):601-605.
[6]李爱丽.早产儿脑损伤的危险因素及预后[J].中国实用神经疾病杂志,2017,20(11):103-105. DOI:10. 3969/j. issn. 1673-5110. 2017. 11. 041.Li AL. Risk factors and prognosis of brain injury in premature infants[J]. Chinese Journal of Practical Nervous Diseases,2017,20(11):103-105. DOI:10. 3969/j. issn. 1673-5110. 2017.11. 041.
[7]李杰,王译,李晓华,等.未足月胎膜早破后极低出生体重儿脑损伤的危险因素分析[J].西南医科大学学报,2017,40(5):475-479. DOI:10. 3969/j. issn. 2096-3351. 2017. 05. 014.Li J,Wang Y,Li XH,et al. Risk factors for brain injury in very-low-birth-weight infants after preterm premature rupture of the membranes[J]. Journal of Luzhou Medical College,2017,40(5):475-479. DOI:10. 3969/j. issn. 2096-3351. 2017. 05. 014.
[8]牟静,华子瑜.新生儿脑病相关危险因素研究进展[J].儿科药学杂志,2018,24(1):57-60. DOI:10. 13407/j. cnki. jpp. 1672-108X. 2018. 01. 020.Mou J, Hua ZY. Research progress on risk factors related to neonatal encephalopathy[J]. Journal of Pediatric Pharmacy,2018,24(1):57-60. DOI:10. 13407/j. cnki. jpp. 1672-108X.2018. 01. 020.
[9]曹蓓,彭湘莲,曾云清.新生儿高氨血症相关影响因素分析[J].现代诊断与治疗,2013,24(3):668-669. DOI:10. 3969/j. issn.1001-8174. 2013. 03. 144.Cao B,Peng XL,Zeng YQ,et al. Analysis of related factors of neonatal hyperammonemia[J]. Modern Diagnosis&Treatment,2013,24(3):668-669. DOI:10. 3969/j. issn. 1001-8174. 2013.03. 144.
[10]李智英,司徒妙琼,吕林华.低出生体质量儿PICC置管后导管相关并发症的相关因素分析[J].重庆医学,2017,46(34):4886-4888. DOI:10. 3969/j. issn. 1671-8348. 2017. 34. 048.Li ZY, Situ MQ, Lyu LH. Related factors of catheter-related complications in low birth weight infants after PICC catheterization[J].Chongqing Medicine,2017,46(34):4886-4888. DOI:10. 3969/j. issn. 1671-8348. 2017. 34. 048.
[11]袁继红.早产儿脑室内出血高危因素分析与护理对策[J].公共卫生与预防医学,2016,27(6):116-117.Yuan JH. Analysis of high risk factors of intraventricular hemorrhage in premature infants and nursing countermeasures[J]. Journal of Public Health and Preventive Medicine,2016,27(6):116-117.
[12]谭竹,王莉.围产期早产儿脑病危险因素研究进展[J].中华临床医师杂志(电子版),2016,10(2):252-255. DOI:10. 3877/cma. j. issn. 1674-0785. 2016. 02. 022.Tan Z,Wang L. Research progress of perinatal risk factors of premature encephalopathy[J]. Chinese Journal of Clinicians(Electronic Edition),2016,10(2):252-255. DOI:10. 3877/cma. j. issn. 1674-0785. 2016. 02. 022.
[13]周光鹏,朱志军,孙丽莹,等.活体肝移植治疗鸟氨酸氨甲酰基转移酶缺乏症3例报告及文献复习[J].首都医科大学学报,2017,38(6):824-826. DOI:10. 3969/j. issn. 1006-7795. 2017.06. 009.Zhou GP,Zhu ZJ,Sun LY,et al. Living donor liver transplantation for ornithine carbamyltransferase deficiency:3 cases report and literature review[J]. Journal of Capital Medical University,2017,38(6):824-826. DOI:10. 3969/j. issn. 1006-7795. 2017. 06. 009.
[14]张喆,贺娟,陈晓文,等.新生儿高氨血症30例[J].实用儿科临床杂志,2011,26(12):949-951. DOI:10. 3969/j. issn. 1003-515X. 2011. 12. 020.Zhang Z,He J,Chen XW,et al. Clinical analysis of hyperammonemia in 30 neonates[J]. Journal of Applied Clinical Pediatrics,2011,26(12):949-951. DOI:10. 3969/j. issn. 1003-515X. 2011.12. 020.
[15]冯向春,王娜,徐元芹.青岛地区90例高危新生儿遗传代谢病的研究[J].中国优生与遗传杂志,2013,21(8):93-94. DOI:10. 13404/j. cnki. cjbhh. 2013. 08. 075.Feng XC,Wang N,Xu YQ. Study of inherited metabolism diseases in 90 newborn infants with high risk[J]. Chinese Journal of Birth Health&Heredity,2013,21(8):93-94. DOI:10. 13404/j. cnki.cjbhh. 2013. 08. 075.
[16]岳晓红.浅析干化学法测定患儿血氨的影响因素及质量控制[J].中国卫生检验杂志,2015,25(24):4362,4365.Yue XH. Influencing factors and quality control of dry chemical method for determination of blood ammonia in children[J].Chinese Journal of Health Laboratory Technology,2015,25(24):4362,4365.
[17]张媞,徐善森,杨帆,等.丙戊酸治疗癫痫患儿诱发高氨血症的危险因素分析[J].中国临床药理学杂志,2016,32(4):363-365. DOI:10. 13699/j. cnki. 1001-6821. 2016. 04. 026.Zhang T,Xu SS,Yang F,et al. Risk factors for hyperammonemia associated with valproic acid therapy in epileptic children[J]. The Chinese Journal of Clinical Pharmacology,2016,32(4):363-365.DOI:10. 13699/j. cnki. 1001-6821. 2016. 04. 026.